Concierge Care: Is it the answer?
In 2005, the Government Accountability Office reviewed this growing trend for concierge medicine. They decided at the time that there were not enough concierge docs to affect access to care, yet. If that is the case, I wonder what they will do. Will they make it illegal to practice this style of medicine? Will making it against the law not continue the trend of growing dissatisfaction and doctors leaving medicine, thus the path to a physician shortage?
Here's another question. If doctors choosing this practice model are happier overall, providing higher quality, more compassionate care, wouldn't that increase the number of physicians wanting to become primary care physicians, because of a renewed chance for job satisfaction in this specialty? After all, why are more and more residents choosing subspecialties? Is it because they love that aspect of medicine, or it is also because they know that it offers greater monetary rewards? Let's be honest, for as much as society would like to believe that people become doctors to help the greater good, doctors still have to live in the practical world of paying for their living and for their other dreams, which may include owning a home, having a family, being able to take quality vacations, or pursuing a hobby or outside passion. Doctors are no longer the unidimensional workers they once were. People have varied interests, and having quality of life is becoming ever more important for the coming generation of doctors.
The other argument against concierge care is that it creates a stratified healthcare system, providing the best care to those that can afford it. This is a tough one. How do you argue against that? Unfortunately, everything else in society is stratified. Not everyone gets to eat in the best restaurants, fly first class, own a large home, go on a yearly vacation.... the list goes on. Come on, our society is stratified by money. That is what capitalism is all about, because even the poorest can make it. Whereas in a communist system with universal everything, the poorest stay poor and the rich stay rich. Does this justify it? Hey, one's health is an investment. The same people that don't want to pay for it are out there buying ipods and xbox's and paying for plastic surgery. Where there's a will, there's a way. It's just that America's values are skewed. Government could provide low-income housing and further tax breaks so that the lower class and the lower middle class could afford their healthcare. The old model simply doesn't work, because healthcare dictated by those that are trying to not pay for it (i.e. insurance companies) just doesn't work.
So what should the emphasis be with patient-centered care? Well, make it a true patient- doctor alliance. Concentrate on preventive care to save the healthcare system money. Allow time to create a plan of action and educate patients on how to take good care of themselves.
Is concierge care the answer? In many ways it's a better model than what has developed in the current system. The current system thinks that doctors are some incredible superheroes able to take care of a multitude of problems in minimal time. This is simply not possible. Good care does NOT happen in a 5 minute visit. Even a 15 minute visit is pushing it for patients with multi-system problems. Concierge care brings reality back to medicine. Insurance companies have corporatized medicine beyond human capabilities. Concierge care is humanizing it again. I'm trying to find the answers, and concierge, patient-centered care is very attractive. Let's make the patient the boss again, and work for them, instead of the insurance companies.
And until I convert, I'm following the low-overhead micropractice model to make this process of building a practice from the ground up more palatable.